P - 77573qf�c REQUEST FOR ELECTRI L I TI �`�
I 1� c7 C� �- 3 2 9� Minnesota Board of Electricity p�0��/ ��y ��� :
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �.
+ ' (651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us �' "
Descnbe -4siny tl� back oithe whde cqpy rf necessarv - the worlyoovAr
0 to 400 Ampere a$25
401 to 800 Am ere �$50
Above 800 Am ere a$75
IRCUITS / FEEDERS
0 to 200 Am re $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNAL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Unfts @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lightin ReVofit $.25 per Fi�Rure
Center Pivot i' ation Boom $40
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5
Se arate Bondi Ins 'on $20
Special Ins ection $30 per Hour
Special Ins ection $.31 r Mile
THIS INSTALLATION MAY BE ORDERED
I lili ll lil Ii l�l Il ili Il ifl II I!I II III II Iil �� I�V
18683292
ed by this request:
C�
Outdoor Li hting Standard @ $1
Traffic Si nal Standard $5
Supplemental Fee $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ection Tri s $20
Investi ative Fee
Reins ection Fee a $20
TOTALFEE
(minimum total fee is $20) �
I hereby certify that I inspeded the electripl installation desaibed herein on the dates stated: �
, _ Z� �cS
EXPIRFD I AS4N0 pq�
IECTED IF NOT COMPLETED WITHIN 12 MONTHS
fA
Name
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r
❑ OWNER and hereby
Range
cny
Cou y
ro(2 P bers Induding Area Code
/ )
Master Electrician or Power Limited Technician
License Number
o(2 P o Numbers Including Area Code
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E -0000'IA4fi a � �nna